Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study

Jennifer L. Proper; David A. Wacker; Salma Shaker; Jamie Heisdorffer; Rami M. Shaker; Larissa T. Shiue; Kathryn M. Pendleton; Lianne K. Siegel; Ronald A. Reilkoff

doi:10.1097/CCE.0000000000000864

Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study

Jennifer L. Proper, David A. Wacker, Salma Shaker, Jamie Heisdorffer, Rami M. Shaker, Larissa T. Shiue, Kathryn M. Pendleton, Lianne K. Siegel, Ronald A. Reilkoff

Research output: Contribution to journal › Article › peer-review

Abstract

IMPORTANCE: Provider staffing models for ICUs are generally based on pragmatic necessities and historical norms at individual institutions. A better understanding of the role that provider staffing models play in determining patient outcomes and optimizing use of ICU resources is needed. OBJECTIVES: To explore the impact of transitioning from a low- to high-intensity intensivist staffing model on patient outcomes and unit composition. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational before-and-after study of adult ICU patients admitted to a single community hospital ICU before (October 2016-May 2017) and after (June 2017-November 2017) the transition to a high-intensity ICU staffing model. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, ICU length of stay (LOS), and unit composition characteristics including type (e.g., medical, surgical) and purpose (ICU-specific intervention vs close monitoring only) of admission. RESULTS: For the primary outcome, 1,219 subjects were included (779 low-intensity, 440 high-intensity). In multivariable analysis, the transition to a high-intensity staffing model was not associated with a decrease in 30-day (odds ratio [OR], 0.90; 95% CI, 0.61-1.34; p = 0.62) or in-hospital (OR, 0.89; 95% CI, 0.57-1.38; p = 0.60) mortality, nor ICU LOS. However, the proportion of patients admitted to the ICU without an ICU-specific need did decrease under the high-intensity staffing model (27.2% low-intensity to 17.5% high-intensity; p < 0.001). CONCLUSIONS AND RELEVANCE: Multivariable analysis showed no association between transition to a high-intensity ICU staffing model and mortality or LOS outcomes; however, the proportion of patients admitted without an ICU-specific need decreased under the high-intensity model. Further research is needed to determine whether a high-intensity staffing model may lead to more efficient ICU bed usage.

Original language	English (US)
Pages (from-to)	E0864
Journal	Critical Care Explorations
Volume	5
Issue number	2
DOIs	https://doi.org/10.1097/CCE.0000000000000864
State	Published - Feb 6 2023

Bibliographical note

Funding Information:
This work was funded by the University of Minnesota Critical Care Program (grant to Dr. Reilkoff). Support was also provided by the University of Minnesota Clinical and Translational Science Institute (Grant Number UL1TR002494 from the National Institutes of Health’s National Center for Advancing Translational Sciences) in the form of access to Research Electronic Data Capture database software.

Publisher Copyright:
© Critical Care Explorations. All rights reserved.

Keywords

hospital mortality
intensive care unit
intensive care unit triage
intensivist staffing
length of stay

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10.1097/CCE.0000000000000864

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@article{796ced02bcde479296958c4439942025,

title = "Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study",

abstract = "IMPORTANCE: Provider staffing models for ICUs are generally based on pragmatic necessities and historical norms at individual institutions. A better understanding of the role that provider staffing models play in determining patient outcomes and optimizing use of ICU resources is needed. OBJECTIVES: To explore the impact of transitioning from a low- to high-intensity intensivist staffing model on patient outcomes and unit composition. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational before-and-after study of adult ICU patients admitted to a single community hospital ICU before (October 2016-May 2017) and after (June 2017-November 2017) the transition to a high-intensity ICU staffing model. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, ICU length of stay (LOS), and unit composition characteristics including type (e.g., medical, surgical) and purpose (ICU-specific intervention vs close monitoring only) of admission. RESULTS: For the primary outcome, 1,219 subjects were included (779 low-intensity, 440 high-intensity). In multivariable analysis, the transition to a high-intensity staffing model was not associated with a decrease in 30-day (odds ratio [OR], 0.90; 95% CI, 0.61-1.34; p = 0.62) or in-hospital (OR, 0.89; 95% CI, 0.57-1.38; p = 0.60) mortality, nor ICU LOS. However, the proportion of patients admitted to the ICU without an ICU-specific need did decrease under the high-intensity staffing model (27.2% low-intensity to 17.5% high-intensity; p < 0.001). CONCLUSIONS AND RELEVANCE: Multivariable analysis showed no association between transition to a high-intensity ICU staffing model and mortality or LOS outcomes; however, the proportion of patients admitted without an ICU-specific need decreased under the high-intensity model. Further research is needed to determine whether a high-intensity staffing model may lead to more efficient ICU bed usage.",

keywords = "hospital mortality, intensive care unit, intensive care unit triage, intensivist staffing, length of stay",

author = "Proper, {Jennifer L.} and Wacker, {David A.} and Salma Shaker and Jamie Heisdorffer and Shaker, {Rami M.} and Shiue, {Larissa T.} and Pendleton, {Kathryn M.} and Siegel, {Lianne K.} and Reilkoff, {Ronald A.}",

note = "Funding Information: This work was funded by the University of Minnesota Critical Care Program (grant to Dr. Reilkoff). Support was also provided by the University of Minnesota Clinical and Translational Science Institute (Grant Number UL1TR002494 from the National Institutes of Health{\textquoteright}s National Center for Advancing Translational Sciences) in the form of access to Research Electronic Data Capture database software. Publisher Copyright: {\textcopyright} Critical Care Explorations. All rights reserved.",

year = "2023",

month = feb,

day = "6",

doi = "10.1097/CCE.0000000000000864",

language = "English (US)",

volume = "5",

pages = "E0864",

journal = "Critical Care Explorations",

issn = "2639-8028",

publisher = "Lippincott Williams and Wilkins",

number = "2",

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TY - JOUR

T1 - Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model

T2 - A Before-and-After Study

AU - Proper, Jennifer L.

AU - Wacker, David A.

AU - Shaker, Salma

AU - Heisdorffer, Jamie

AU - Shaker, Rami M.

AU - Shiue, Larissa T.

AU - Pendleton, Kathryn M.

AU - Siegel, Lianne K.

AU - Reilkoff, Ronald A.

N1 - Funding Information: This work was funded by the University of Minnesota Critical Care Program (grant to Dr. Reilkoff). Support was also provided by the University of Minnesota Clinical and Translational Science Institute (Grant Number UL1TR002494 from the National Institutes of Health’s National Center for Advancing Translational Sciences) in the form of access to Research Electronic Data Capture database software. Publisher Copyright: © Critical Care Explorations. All rights reserved.

PY - 2023/2/6

Y1 - 2023/2/6

N2 - IMPORTANCE: Provider staffing models for ICUs are generally based on pragmatic necessities and historical norms at individual institutions. A better understanding of the role that provider staffing models play in determining patient outcomes and optimizing use of ICU resources is needed. OBJECTIVES: To explore the impact of transitioning from a low- to high-intensity intensivist staffing model on patient outcomes and unit composition. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational before-and-after study of adult ICU patients admitted to a single community hospital ICU before (October 2016-May 2017) and after (June 2017-November 2017) the transition to a high-intensity ICU staffing model. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, ICU length of stay (LOS), and unit composition characteristics including type (e.g., medical, surgical) and purpose (ICU-specific intervention vs close monitoring only) of admission. RESULTS: For the primary outcome, 1,219 subjects were included (779 low-intensity, 440 high-intensity). In multivariable analysis, the transition to a high-intensity staffing model was not associated with a decrease in 30-day (odds ratio [OR], 0.90; 95% CI, 0.61-1.34; p = 0.62) or in-hospital (OR, 0.89; 95% CI, 0.57-1.38; p = 0.60) mortality, nor ICU LOS. However, the proportion of patients admitted to the ICU without an ICU-specific need did decrease under the high-intensity staffing model (27.2% low-intensity to 17.5% high-intensity; p < 0.001). CONCLUSIONS AND RELEVANCE: Multivariable analysis showed no association between transition to a high-intensity ICU staffing model and mortality or LOS outcomes; however, the proportion of patients admitted without an ICU-specific need decreased under the high-intensity model. Further research is needed to determine whether a high-intensity staffing model may lead to more efficient ICU bed usage.

AB - IMPORTANCE: Provider staffing models for ICUs are generally based on pragmatic necessities and historical norms at individual institutions. A better understanding of the role that provider staffing models play in determining patient outcomes and optimizing use of ICU resources is needed. OBJECTIVES: To explore the impact of transitioning from a low- to high-intensity intensivist staffing model on patient outcomes and unit composition. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational before-and-after study of adult ICU patients admitted to a single community hospital ICU before (October 2016-May 2017) and after (June 2017-November 2017) the transition to a high-intensity ICU staffing model. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, ICU length of stay (LOS), and unit composition characteristics including type (e.g., medical, surgical) and purpose (ICU-specific intervention vs close monitoring only) of admission. RESULTS: For the primary outcome, 1,219 subjects were included (779 low-intensity, 440 high-intensity). In multivariable analysis, the transition to a high-intensity staffing model was not associated with a decrease in 30-day (odds ratio [OR], 0.90; 95% CI, 0.61-1.34; p = 0.62) or in-hospital (OR, 0.89; 95% CI, 0.57-1.38; p = 0.60) mortality, nor ICU LOS. However, the proportion of patients admitted to the ICU without an ICU-specific need did decrease under the high-intensity staffing model (27.2% low-intensity to 17.5% high-intensity; p < 0.001). CONCLUSIONS AND RELEVANCE: Multivariable analysis showed no association between transition to a high-intensity ICU staffing model and mortality or LOS outcomes; however, the proportion of patients admitted without an ICU-specific need decreased under the high-intensity model. Further research is needed to determine whether a high-intensity staffing model may lead to more efficient ICU bed usage.

KW - hospital mortality

KW - intensive care unit

KW - intensive care unit triage

KW - intensivist staffing

KW - length of stay

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SN - 2639-8028

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ER -

Patient Outcomes and Unit Composition With Transition to a High-Intensity ICU Staffing Model: A Before-and-After Study

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